This thesis examines the influence of different forms of participation in psychiatric hospital admission, and inpatient psychiatric treatment planning. The first chapter presents a systematic review and meta-synthesis of qualitative studies into patients’ experiences of treatment planning and decision making in psychiatric hospital. We found across the twenty one studies reviewed, that the degree and quality of participation possible in inpatient systems has important emotional and psychological consequences for patients. A novel model – the ‘maze’ was developed which describes the synthesis of patient experiences. We suggest ways for services to use the findings of the review to inform ward-based interventions to facilitate reciprocity in decision making and provide opportunities for patients to reflect on the impact of practices.
The second chapter describes a spatial epidemiological investigation into
the relative utility of political participation and income deprivation as predictors of neighbourhood level psychiatric admission rates across Wales. Multilevel
regression modelling was used to account for non-independent, non-normally
distributed outcome data and showed that whereas neighbourhood political
participation is associated with lower admission rates, this association is not
significant when neighbourhood income deprivation is taken into account.
In the third chapter, the results of the literature review and empirical paper
are discussed in the context of relevant theory, and methodological considerations, clinical implications and personal reflections are explored.